Campbell Brett A, Flormann Victoria B, Davis Roger B, Mallur Pavan S
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.
Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.
Laryngoscope. 2024 Apr;134(4):1749-1756. doi: 10.1002/lary.31072. Epub 2023 Sep 29.
Studies examining electromyography (EMG)-guided laryngeal onobotulinumtoxinA (BTxA) injection for chronic cough reveal promising efficacy, however, are limited by small cohorts and absent quantifiable outcomes. It further remains unclear if pulmonary disease limits efficacy, or if vagal motor neuropathy prognosticates response. We hypothesize BTxA injection results in qualitative improvement in cough, decrease in Cough Severity Index (CSI), no change in Voice Handicap Index-10 (VHI-10), and complication rates comparable to historical data. We also examine the correlation of pulmonary comorbidities and vocal fold hypomobility with treatment efficacy.
Retrospective review.
Charts for patients receiving percutaneous adductor compartment BTxA injection for cough were reviewed for the binary outcome of patient-reported presence or absence of improvement. Generalized estimating equations regression models were used to analyze the change in CSI (ΔCSI) and the correlation of ΔCSI with qualitative outcomes. Multivariable analyses were used to examine correlation of vocal fold hypomobility and pulmonary disease with qualitative outcomes and ΔCSI.
Forty-seven patients underwent 197 BTxA injections from June 2012 to June 2022. A statistical proportion of 0.698 (0.599-0.813, p < 0.0001) or 69.8% of injections resulted in subjective improvement. Mean ΔCSI was -2.12 (0.22-4.02, p < 0.05), indicating overall improvement. With and without subjective improvement, estimated ΔCSI was -4.43 and +2.68, respectively (p < 0.0001). VHI-10 did not change (0.69, p = 0.483). Neither pulmonary disease nor vocal fold hypomobility correlated with subjective improvement or ΔCSI. Dysphagia occurred following 15 (7.6%) injections with no aspiration pneumonia or hospitalization.
BTxA injection to the laryngeal adductors may effectively treat cough with limited risk for serious complications.
4 Laryngoscope, 134:1749-1756, 2024.
研究采用肌电图（EMG）引导下喉部注射A型肉毒杆菌毒素（BTxA）治疗慢性咳嗽，显示出有前景的疗效，然而，受限于小样本队列研究且缺乏可量化的结果。目前仍不清楚肺部疾病是否会限制疗效，或者迷走神经运动神经病是否可预测治疗反应。我们假设BTxA注射可使咳嗽得到定性改善，咳嗽严重程度指数（CSI）降低，嗓音障碍指数-10（VHI-10）无变化，且并发症发生率与历史数据相当。我们还研究肺部合并症和声带运动减弱与治疗效果的相关性。
回顾性研究。
回顾接受经皮内收肌间隙BTxA注射治疗咳嗽患者的病历，以获取患者报告的改善与否这一二分结果。采用广义估计方程回归模型分析CSI的变化（ΔCSI）以及ΔCSI与定性结果的相关性。多变量分析用于研究声带运动减弱和肺部疾病与定性结果及ΔCSI的相关性。
2012年6月至2022年6月期间，47例患者接受了197次BTxA注射。统计学比例为0.698（0.599 - 0.813，p < 0.0001），即69.8%的注射导致主观改善。平均ΔCSI为-2.12（0.22 - 4.02，p < 0.05），表明总体有所改善。无论有无主观改善，估计的ΔCSI分别为-4.43和+2.68（p < 0.0001）。VHI-10未发生变化（0.69，p = 0.483）。肺部疾病和声带运动减弱均与主观改善或ΔCSI无关。15次（7.6%）注射后出现吞咽困难，未发生吸入性肺炎或住院情况。
喉部内收肌注射BTxA可能有效治疗咳嗽，严重并发症风险有限。
4 喉镜，134:1749 - 1756，2024年。
